How to write medical information in plain English

Introduction

This guide gives you an idea of how the plain English approach can make your notices, letters and medical information clearer.

The guide will be useful if you work for:

the Health Service;

an NHS Trust; or

a company in the health sector.

Ten tips for clearer writing

These are recommendations, not rules: be flexible!

Think of your audience, not yourself.

Don't try to impress people by using your language to show off: keep it as straightforward as possible. Imagine you are speaking to someone, and write in that more relaxed way.

Use short sentences.

A good average sentence length ('ASL') is 15 to 20 words. Use shorter ones for 'punch'. Longer ones should not have more than three items of information; otherwise they get overloaded, and readers lose track.

Be careful with technical language.

Be prepared to explain any technical language and acronyms - will your audience know them? (See the A to Z.)

Use 'active' verbs mainly, not 'passive' ones.

Using the active is shorter and clearer; using the passive can be longer and sometimes confusing. Try to write 90% in the active. The other 10% - yes, you will find the passive more suitable.

'A report will be sent to your doctor.' (passive)

'We will send a report to your doctor.' (active)

Don't underline.

It is tempting to do this, but it achieves very little. It can be distracting, making the text harder to read. Proper spacing does the job. And :

Use lower case bold for emphasis, not block capitals.

Block capitals are hard to read, so don't put text in upper case. Use lower case bold. For headings, if need be, use large lower case bold.

Put complex information into bullet points.

Plan and draft your writing. If you have a lot of information to convey, make it easier for the reader by breaking it up into logical 'stepping stones'.

Use everyday words.

Big words, foreign phrases, bursts of Latin and so on usually confuse people. Consequently, it is a sine qua non of plain English not to write too polysyllabically! So, for plain English, use everyday words.

Write small numbers.

In text, write numbers one to nine as words; with 10 and upwards, put the figure. But be flexible. Probably with medicines it is clearer to write 'Take 2 tablets 4 times a day.'

Use the 'personal touch'.

Any organisation, however grand, can quickly become 'we'. Then the 'customer', 'client' or 'patient' simply becomes 'you'.

'An information helpline is also operated by ABC Hospital Trust for the convenience of patients.'

becomes:

'We also operate an information helpline for your convenience.'

Online communication/records

Communication between medical professionals and patients has changed, with all official correspondence now available online. This means you need to take more care than ever over how you communicate a medical issue. The results will form a permanent digital record, and will often have to stand alone as an explanation or interpretation of a patient’s health. There is no room for error or ambiguity – patients may read the information alone without any further information or re-explanation.

Notices

Here is an example of plain English in action.

This notice was put up by a hospital administrator. Below is the same notice, but put into plain English.

Dear Colleague

RE: CAR PARKING - OUTSIDE WARD 10 AND 11 AREA OF HOSPITAL

It is fully acknowledged that on site car parking is currently very limited and in this respect plans are currently being examined with a view to alleviating the problems.

One current area of concern is the area adjacent to Wards 10 and 11, and during a recent fire alarm call, which fortunately turned out to be an non emergency, the fire vehicles had extreme difficulty in manoeuvring in this area. In the event of a real fire you can rest assured that these vehicles would take whatever steps were necessary to reach their destination as quickly as possible, and therefore it is imperative that the perimeter road around the hospital site is left as clear as is possible. To help us with these problems both members of staff or visitors to the hospital who normally park in that area will now be able to park their vehicles in the Hospital Transport compound between the hours of 8.15 a.m. until 4.00 p.m. The gates of the compound will be left open and I ask that this space is utilised. May I also ask that it is important that no private vehicles remain in the compound after 4.00 p.m., due to the fact that transport Department vehicles will return to the site after that time and need to be in a secure area overnight.

The assistance of everybody in this matter is very much appreciated.

For the revised version, we have:

removed the heading (with its block capitals and underlining);

put the topic into the first sentence (now 19 words, not 29);

shortened the sentences in paragraph two;

used 'active' verbs; and

put the main instructions in bullet points.

Dear Colleague

We realise that car parking on site is very limited, and we are making plans to solve the problem.

One main difficulty is the area next to wards 10 and 11. During a recent fire alarm call (which turned out not to be an emergency) the fire engines had extreme difficulty getting through this area. In a real fire, they would take whatever action they needed to reach the emergency. So, you must keep the road around this area clear.

To help solve these problems, please:

park your vehicle in the Hospital transport compound, between 8.15am and 4pm; then

remove your vehicle by 4pm, as we need the compound overnight for Transport Department vehicles.

Thank you for your co-operation.

Comments

The revised version is easier to take in because it is more direct.

The original (ignoring the heading) was much longer: 230 words, with an average sentence length ('ASL') of about 33 words. The second is 119 words, with an ASL of 13 words.

Passive verbs have become active. For example:

'it is fully acknowledged...' becomes 'we acknowledge (realise)...'

'plans are currently being examined...' becomes 'we are making plans...'

Wordiness has been pruned. For example:

the repeating of 'currently' and 'current'

'It is imperative that...' becomes 'you must...'

'due to the fact that...' becomes 'as...'

'To help with these problems both members of staff or visitors...' reads as though only two people work there. Remove 'both'

Overall, the second version gives you and your busy colleagues an easier ride. You don't have to fight your way through the words to get to the message.

Letters

On the next page is a 'standard letter' sent out by a hospital to patients telling them when they were due to come into hospital.

If you received this, would you be clear about what was happening? See if you can rewrite it using plain English, so that it answers these questions.

Is it one appointment or two?

Would two separate letters be better?

What is 'pre-assessment'?

Will having a cough or cold mean I can't come?

What if I fail to keep the pre-assessment appointment?

ADMISSION TO HOSPITAL

Dear

The following date for your operation has now been booked:-

CONSULTANT MR SMITH

HOSPITAL NUMBER G 12345

OPERATION DATE 9-11-00

WOMEN'S HEALTH UNIT (Ward 17/18)

Should there be any difficulties regarding the date of your surgery please telephone 76543 Monday-Friday, between 10.00 - 15.00 when someone will be available to take your call.

Your pre-assessment appointment is enclosed. The exact day of your admission will be confirmed at pre-assessment and is most likely to be the day prior to your operation.

We must, however, point out that at this stage we cannot guarantee bed availability. Will you therefore please telephone 76542 a couple of hours before your admission to confirm this arrangement. If you are unable to attend please telephone us as soon as possible to enable us to offer the bed to someone else.

If you develop a cough or cold prior to admission, please contact us as soon as possible.

Please report directly to the ward.

If you fail to arrive for this admission, you will not automatically be sent another admission date.

Yours sincerely

Can you do better than this?

You can get help from our website - download 'How to write letters in plainEnglish'.

Or come on the medical writing course to see how you and others would tackle it.

Over-the-counter (OTC) medicines

Information about OTC medicines needs to be easy to understand.

Here are some tips, followed by difficult examples from various medicines.

Use a reasonable type size on bottles and leaflets. Older people especially have trouble with tiny type. Some bottles, where space is tight, have labels that fold out into leaflets.

Use lower case bold for emphasis, not block capitals. And avoid italics, even though the EU guidelines recommend them!

Use ordinary words as far as possible. If complex medical words are needed, be prepared to explain them.

Use 'expiry dates' that are easy to read. Some are stamped so small that people can't find them, let alone make out the date.

Use plenty of white space, and don't cloud the message with watermarking (pictures faded in under the text).

Examples

The following is a random selection taken from labels on common painkillers, ear drops and so on. Many people would know some of the language through having spoken to a doctor. But many would find the labelling puzzling or alarming.

(The A-Z of medical terms covers most of the medical words used here.)

'These tablets are for oral use...'

'Five drops to be instilled...'

'Could cause dyspepsia...'

'Consult your doctor first if you are already taking medication for fluid retention using diuretics...'

'Do not take these tablets if you are already taking another non-steroidal anti-inflammatory drug (NSAIDs)...'

'This adult nasal spray is for local application in the nose to give symptomatic relief of nasal congestion (including in colds), perennial and allergic rhinitis (including hayfever) and sinusitis.' [30 words]

(A plainer version)

'Use this spray on adults only. It will help relieve stuffed-up nose, inflamed sinuses and hay fever. Spray directly into the nose.'

And finally...

'Do not take this product if your doctor has told you that you have phenylketonuria...'

A to Z of medical terms

Medical terms or phrases can often baffle your patients or customers. Try to watch out for this, and use ordinary language where possible. Be prepared to explain technical terms if you need to use them. What follows in this A to Z is a selection of words that people may find troublesome. It is not a 'correct' medical dictionary, and it is by no means complete, but it's a start!

A and E

accident and emergency

AID

artificial insemination by a donor

AIDS

acquired immune deficiency syndrome

amnesia

loss of memory

analgesic

something that lessens pain

anastomosing

joining together

aneurysm

a swelling in an artery

antibiotic

a chemical used to inhibit or stop the growth of bacteria

antipyretic

substance that reduces temperature

arthroplasty

repairing a joint (such as a hip replacement)

astigmatism

uneven curvature of the eye that can lead to blurring or lack of focus

atrophy

a wasting away (of tissues, such as muscles)

biopsy

removing a small amount of tissue for examination in the laboratory

booked admissions

allowing patients to arrange with the hospital a date to come in for an operation

bronchoscopy

examining the bronchial tubes with a small flexible camera tube (an endoscope)

biopsy

removing a small amount of tissue for examination in the laboratory

cardiology

study and treatment of the heart

cardiothoracic

to do with the heart and lungs

chemotherapy

treatment (usually of cancer) by drugs

chronic

a long-lasting disease that changes slowly

cirrhosis

progressive disease of the liver (often associated with alcohol abuse)

coeliac

to do with the abdomen (usually the small intestine)

colonoscopy

examining the colon (bowel) with an endoscope

colorectal

to do with the colon and rectum

colposcopy

examining the vagina or cervix with an endoscope

CPM

continuous passive motion: a machine with a motor to help flex limbs

CT scan

computerised tomography is a type of three-dimensional X-ray giving far more information than a normal X-ray

cystoscopy

examining the bladder with an endoscope

D and C

dilation and curettage: widening of the cervix to take a sample scraping of the lining of the womb

dialysis

filtering the blood, cleansing it

discharge

'going home' is more reassuring; keep 'discharge' for running sores!

diuretic

a drug that helps to remove excess water from the body

dysfunction

not working properly

dyspepsia

indigestion; upset stomach

ECT

electroconvulsive (electroshock) treatment

ectopic

outside (ectopic pregnancy; a baby developing outside the womb)

electrocardiogram

a graph showing the electrical activity of the heart, including the heartbeat

electrocardiograph

a machine used to produce an electrocardiogram

embolism

blocking of an artery (by a blood clot or air bubble)

encephalitis

inflammation of the brain

endometriosis

the presence of tissue similar to the lining of the womb at other sites in the pelvis

endoscope

various types of flexible tube with a fibre-optic camera for seeing inside organs

enuresis

bed-wetting

epidural

usually refers to an injection in the lower spine, often given during childbirth to reduce pain

faeces

solid waste from the bowel; motions; stools

femur

thigh bone

femur

thigh bone

fracture

a broken bone:

'compound'- with a skin wound

'closed' - without a skin wound

'comminuted'- in many pieces

gastroenterology

study and treatment of the stomach and intestines. The disease is 'gastroenteritis'

GU

genito-urinary (as in 'GU' department); urogenital; to do with reproduction and urination; dealing also with sexually transmitted diseases

gynaecology

study and treatment of the female genital tract, including reproduction

haematology

study of the blood

haemophilia

severe bleeding, without clotting; so, 'haemophiliac': a person with this problem

haemorrhoids

piles

hepatic

to do with the liver; so, hepatitis: liver disease HIV human immunodeficiency virus; can lead to AIDS

ICU

intensive care unit

image intensifier

instant x-ray images on a TV monitor

jaundice

a yellowing of the skin or the whites of the eyes due to liver disease

jugular

of the neck or throat; so, jugular vein

keratic

horny, hardening of the skin

keratitis

inflammation of the cornea of the eye

kidney

organ that filters blood and excretes urine

kymograph

instrument that measures blood pressure

labial

relating to lips

labyrinthitis

inflammation of the inner ear, causing dizziness

lachrymal duct

the channel near the eye that produces tears

lactation

production of milk to breast-feed babies

laparoscopy

examining the abdomen with an endoscope

laryngitis

inflammation of the vocal chords (larynx)

laxative

treatment for constipation

lithotripsy

breaking up kidney or gall stones using ultrasound

mammography

examining the breasts by x-ray

maxillofacial

to do with the face or jaw; (removing a wisdom tooth)

metastasis

the spreading of tumour cells round the body

miscible

able to be mixed with another liquid

MMR

measles, mumps, rubella: the three-in-one vaccination for children

motor neurone disease

a progressive wasting of the nerves that control your muscles

myocardial infarction

a heart attack; seizure of heart muscle

nasal

to do with the nose

nauseous

feeling like you are going to be sick

necrotic

used to describe dead cells or tissue

neoplasm

new and abnormal growth; tumour

neurology

study of the nervous system

neurophysiology

study of the changes associated with the activity of the nervous system

obstetrics

care and control of pregnancy and childbirth

oedema

swelling caused by fluid

oncology

study and treatment of tumours

ophthalmic

to do with the eye; ophthalmology - its treatment

orthodontics

dentistry specialising in correcting teeth problems

orthopaedics

treatment of bones and muscles (originally, in children)

osteopathy

treatment by manipulation and massage of muscles and bones

osteoporosis

brittle bones; weakening of the bones

otolaryngology

treatment of diseases of the ear and throat

paediatrics

study and treatment of children and their diseases

palliative care

lessening pain without curing the symptoms

paraplegia

paralysis of the legs

patella

the kneecap

pathology

study of the causes of disease; the testing (biopsy) of tissue to check for disease

pertussis

whooping cough

phenylketonuria

inherited difficulty in processing an amino acid; can lead to learning difficulties (mental handicap)

physiotherapy

use of physical methods to promote healing such as massage, manipulation and exercise

podiatry

a branch of chiropody

post-op

after the operation

post operative

after the operation

pre-assessment

a hospital appointment before the operation date to check details

pre-med

drug given before an anaesthetic to calm the nerves before an operation

prophylactic

something taken to prevent disease

quadriplegia

paralysis of all four limbs

quarantine

isolation of someone with an infectious or contagious disease (originally for 40 days)

quinsy

abscess on or near the tonsils

radiography

taking x-rays; the x-ray department

radiotherapy

using radiation for treatment (especially of cancer)

renal

to do with the kidneys

rhinitis

inflammation in the nose

sigmoidoscopy

examining the inside of the colon (bowel)

sinusitis

inflammation of the sinuses ('tubes'), usually around the nose

sutures

stitches

syndrome

the set of symptoms associated with a particular disease

thrombolysis

dissolving a blood clot

tomogram

the image produced by a computerised tomography (CT) scan, a very detailed three-dimensional X-ray

trachea

the windpipe

trauma

a wound or injury (usually); emotional shock

triage

sorting out patients according to how urgently they need treatment ('A and E')

urethra

'tube' from the bladder, carrying urine

urology

study and treatment of the urine system

venereal disease

'VD'; sexually transmitted disease

ventricle

a cavity or chamber in the heart or brain

xanthoderma

yellowing of the skin

xeroderma

dry skin ('ichthyosis')

yellow fever

mosquito-borne hepatitis, causing jaundice, maybe death

Copyright

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